CareSource Marketplace Gold Dental, Vision, & Fitness
| Plan Type: | HMO |
| Plan Tier: | Gold |
| Individual Deductible | $2,000 |
| Family Deductible | $4,000 |
| Individual Out of Pocket Max | $6,500 |
| Family Out of Pocket Max | $13,000 |
| Primary Care Visit: | $10 |
| Specialist Visit: | $45 |
| Emergency Room: | 20% Coinsurance after deductible |
| Hospital - Physician: | 20% Coinsurance after deductible |
| Hospital - Facility: | 20% Coinsurance after deductible |
| Link to Full SBC: | https://www.caresource.com/documents/Marketplace-2021-GA-Standard-GoldBase-Enhanced-sum |
| Plan Brochure: | https://www.caresource.com/documents/Marketplace-2021-GA-brochure |
Other Coverage:
| Child Dental: | Yes |
| Adult Dental | Yes |
Prescription Drug Pricing:
| Generic Drugs: | $15 |
| Non-Preferred Brand Drugs: | 40% Coinsurance after deductible |
| Preferred Brand Drugs: | $50 |
| Specialty Drugs: | 40% Coinsurance after deductible |
| Summary of Benefits | https://www.caresource.com/documents/Marketplace-2021-GA-formulary |
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